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General NPI Number Information
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NPI Number | 1891901542
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Entity Type | Individual
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Provider Name | EDNA S. COLON ORTIZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | CALLE 16,C-17,VILLA HUMACAO
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City | HUMACAO
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State | PR
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Zip | 00792-0554
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Country | US
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Telephone | 787-852-0129
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Fax | 787-801-2900
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Provider Business Mailing Address
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Address Line | CALLE 16,C-17,VILLA HUMACAO P.O.BOX 554
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City | HUMACAO
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State | PR
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Zip | 00792-0554
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Country | US
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Telephone | 787-852-0129
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Fax | 787-801-2900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 5964
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License Number State | PR
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